Hospital director Meinir Williams has invited petitioner Emma Griffiths Hughes to work with the board to increase “public disapproval” of the anti-social behaviour.

All buildings, gardens and entrances outside hospitals and GP surgeries run by Betsi Cadwaladr University Health Board (BCUHB) are supposed to be totally smoke-free under board rules.

Patients, staff and visitors are even banned from smoking in their cars when they are parked in BCUHB’s car parks and vaping is forbidden, according to the board’s policy.

But while there are signs on the sites telling people not to smoke, patients in their dressing gowns and at times dragging drip stands are regularly seen lighting up outside Ysbyty Gwynedd, Ysbyty Glan Clwyd and Wrexham Maelor.

Around 140,000 adult patients treated in North Wales’ hospitals and GP surgeries classed themselves as smokers in 2014, statistics show.

But no fines have been issued to rule breakers, with Betsi bosses saying their hands are tied in how much they can do because smoking on their grounds is “not against the law”.

BCUHB said they encouraged staff to challenge smokers who were breaking the rules, but they were often met with a “negative or aggressive reaction” when asked to stub it out.

A spokesperson said: “This understandably makes busy colleagues reluctant to continue asking people to put out their cigarettes or move away from entrances.”

BCUHB said they were “frustrated” that after a series of initiatives – including stop smoking graffiti on pavements outside their hospitals and playing recorded messages from their entrances when a cigarette is lit nearby – people were still disrespecting their requests not to smoke outside their hospitals.

A spokesperson for BCUHB said: “As there is no legal restriction on smoking outside hospitals and other healthcare buildings, we do not have any powers to enforce restrictions on smoking outside entrance areas and in hospital and clinic grounds, for example by issuing fines.”